Bethesda House Training Registration Form

*If you are filling out this form on behalf of a child, please fill out Name, Email Address, and Cell Phone with the information of the parent/guardian and the rest with the information of the child.  Please share the child's/children's names in the other comments section.

Name *
Name
Date of Birth
Date of Birth
Select the seminar or workshop that you are applying for
Photo/video release *
Our staff may be discreetly taking photos or video during this seminar to be used for news or promotional purposes, including print and electronic materials, social media, and our website. If you would rather not have your photo or video taken, please do not select anything.